Section Two: Special Situations

The first section described situations that everyone living with HIV should know about because most people will face them at one time or another. However, our needs change over time and they can differ from person to person. Some people may be concerned about passing HIV on to sex partners. Others are more concerned about how to improve their health and wellness.

In this next section, we talk more about those situations. For example, maybe you're in your 50s or 60s now or you want to get pregnant. You're entitled to live a full life with HIV, including having a family and loving relationships. Read those topics that apply to you.

If Your Sex Partner(s) Is HIV-Negative

Despite what it felt like when you first tested positive, that shouldn't mean the end of sex and romance. Telling your status to partners is more tricky and risky for people living with HIV, but you can still have a fulfilling sexual and romantic life.

Most people with HIV want to protect their HIV-negative partners from becoming infected, and most people do. The easiest and cheapest way to do this is to either refrain from high-risk sex (such as anal or vaginal sex without condoms) or always use a condom. Some people also choose only to have sex with or date other people who are HIV-positive. Below you'll find other things to consider when protecting your partners.

PrEP (Pre-Exposure Prophylaxis)

PrEP is a daily HIV pill that an HIV-negative person takes to prevent transmission (along with using condoms). Taking it as directed can reduce transmission by up to 90%. This is true in both women and men and for both vaginal and anal sex. PrEP is approved by the FDA and should only be done with the help of a doctor. If you have an HIV-negative sex partner, PrEP may be something to explore. For more information, read Project Inform's publications at www.projectinform.org/prep.

Genital Infections

There's more of a chance of passing HIV if you have sex when a sexually transmitted disease like chlamydia or syphilis is present in either partner. Even if symptoms aren't present, active genital infections can still raise the risk. Have your doctor regularly screen for and treat STDs.

Undetectable Viral Load

The chance for passing HIV is much less likely when the positive partner takes HIV meds and stays undetectable over time. Undetectable viral load in the blood is linked to lower and perhaps undetectable viral load in vaginal and anal fluids and semen. However, several things can briefly raise viral load in genital fluids and blood: sexually transmitted infections, other infections that challenge the immune system like hepatitis B or C, or even a recent vaccination.

Foreskin Vs. No Foreskin

Having a foreskin increases the risk because HIV aims for the immune cells found within the foreskin. For straight men during vaginal sex, there's about a 60% lower risk of transmission when he is cut. As for anal sex (straight or gay), it's not as clear how much more protection there is for the man who's cut.

"Sero-Adaptive" Behaviors

Sometimes HIV-positive people change their unprotected sex to lower the risk of passing HIV to others: by sero-sorting, or having sex with someone they think is also HIV-positive; and by sero-positioning, or "bottoming" for an HIV-negative partner.

Sero-sorting with another HIV-positive person increases the risk for super-infection, or getting another strain of HIV which may make it harder to control. This most often occurs during the first months after infection. However, there are probably fewer serious concerns if both partners are on HIV meds and stay undetectable.

Sero-positioning may somewhat reduce the risk for passing HIV, but the HIV-negative top (insertive) can still get HIV through unprotected vaginal and anal sex. This is especially true if breaks in the skin or infections are present, if viral load is detectable, or if the top is uncut.

Since these sero-adaptive behaviors imply unprotected sex, you can still get other sexual infections such as chlamydia, herpes and syphilis, as well as diseases that people don't often think of in terms of sex, like hepatitis C. Recent mini-epidemics of both syphilis and hepatitis C have been seen in HIV-positive gay and bisexual men. Both have a faster progression and are harder to treat in people with HIV.

HIV Criminalization

Some states make it a crime to have sex with an HIV-negative person if you don't disclose you have HIV -- even if you use a condom, take HIV meds, and have an undetectable viral load. In some states, notably in the Midwest and the South, prosecutions are increasing for those people who don't disclose. To learn more about this and how to protect yourself, visit www.seroproject.com.

If You Are Under 25

HIV meds allow most everyone to live a longer, healthier life. It's also true that making this happen takes seeing a doctor and getting regular blood work done. However, younger people -- especially those under 25 years old -- more often aren't in regular medical care. This is especially true of young gay and bisexual men and young African American and Latino men and women.

It's also true that younger people tend to struggle with keeping up with their meds. This probably has to do with having an active social life and other distractions -- like juggling school, working, sports, volunteering and other responsibilities.

These are real issues, but they aren't insurmountable. If you don't have steady health care, consider getting onto your parents' insurance if you can. The Affordable Care Act now allows children up to the age of 26 to be on their parents' plans.

If this doesn't work for you (you may not have told your parents about your HIV), then talk to a case manager about other insurance options. As well, ask someone in your doctor's office or your case manager or pharmacist about ways to remember taking your pills and keeping up with medical appointments.

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